Your Family Clinic LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

948493 Issued in MS

Legal business name

YOUR FAMILY CLINIC LLC

Practice address

514 Old Richton Rd
Petal, MS 39465-2920

Phone

(601) 544-8935

Fax

(601) 544-8935

NPI assigned

Dec 3, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel Tamour Moore, PH.D.

Title

Owner

Phone

(601) 544-8935

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1891192068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MARS HILL RD",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394658343",
            "telephone_number": "601-544-8935",
            "fax_number": "601-544-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 OLD RICHTON RD",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394652920",
            "telephone_number": "601-544-8935",
            "fax_number": "601-544-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "TAMOUR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-544-8935",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MS",
            "license": "948493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861400244",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Michael Weaver, M.D.
• Nathanael Webb
• Thomas M Welsh, PH.D.
• Hayden White, PHARMD
• Charles M Williamson, PT, ATC

• Community/Behavioral Health Agency in Petal, MS
• Providers in Petal, MS by specialty
• Community/Behavioral Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.